Acute Red Eye - Non-emergency Flashcards
Ddx:
Common causes are conjunctivitis and episcleritis.
Subconjunctival haemorrhage:
- What causes spontaneous haemorrhaging?
- What else may cause it?
- What should be investigated if it becomes recurrent?
Trauma:
- What sort of trauma happen to the cornea?
Coughing for example
Trauma
Corneal abrasion
Foreign body
DDx:
Sight-threatening causes which are often painful:
- Keratitis - what is it?
- Scleritis
- Anterior uveitis
- Acute angle-closure glaucoma
THE NEXT 3 ARE EMERGENCIES AND IN THE NEXT DECK
Corneal infection
Conjunctivitis:
What is it?
Bi/unilateral?
What is the most common type?
When is
Inflammation of the conjunctiva, the clear moist membrane covering the exposed sclera and inner eyelids.
Bilateral - may start in one eye before spreading
Viral Conjunctivitis:
What virus usually causes it? - A
Presentation:
- Obvious symptom
- It has a watery discharge. How may it be confused with pus?
- What does it feel like for the patient?
- What type of infection is it associated with?
Management:
- What may be prescribed which relieves symptoms? - 2
- What advice is given? -1
Adenovirus
Acute red eye
It may dry to form a yellow crust so shouldn’t be assumed for pus.
A mild foreign body sensation
Topical lubricants and artificial tears
Strict hand hygiene as highly contagious
Bacterial conjunctivitis:
Common causes are staph or strep. What STI could also cause it due to hand transfer?
Presentation:
- Obvious symptom
- Type of discharge
- What may the patient struggle with in the morning?
Management:
- What type of eyedrops can they be prescribed though it may self-resolves?
- What should not be worn?
Gonorrhoea - MAY BE SEVERE
Chlamydia
Acute red eye
Mucopurulent discharge
Crusting leaves them finding it hard to open their eyes in the morning
Chloramphenicol - antibiotic eye drop
Contact lenses
Allergic conjunctivitis:
As well as acute red eye, you get chemosis. What is it?
What other symptoms do you get?
What time of yr may it appear?
What animal may cause it?
What visual enhancement may also cause it?
Management:
- What can be given for rapid and long term control? Routes - 2
The swelling (or oedema) of the conjunctiva. It is due to the oozing of exudate from abnormally permeable capillaries.
Itchiness and watery eyes
Seasonal - hay fever - summer and spring
Dust mites
Antihistamines
Oral (e.g cetirizine) or Topical (e.g. azalastine)
Episcleritis:
Pathophysiology:
- What is it?
- Bi/unilateral
What may it be a complication of? - 3
Presentation:
- Obvious symptom
- What does it feel like for the patient?
- Other symptoms?
Symptomatic relief:
- What can be prescribed topically and orally?
Inflammation of the episclera - the thin vascular sheet between the conjunctiva and sclera
Bilateral
RA IBD Sarcoidosis ----- Acute red eye Foreign body sensation Dull ache and tenderness -------- Topical lubricants Oral NSAIDs - for inflammation
Keratitis:
What is it?
What may it lead to?
What may cause bacterial infection?
What virus may cause this?
Inflammation of the cornea
Progress to ulceration
Contact-lens wearers with inadequate lens care
Herpes simplex
Keratitis:
Presentation:
- Obvious symptom
- Do patients have pain?
- What other symptoms do they have?
- What may be seen if it was a bacterial cause?
- What is hypopyon and where is it found?
- What may fluorescein stain show?
Acute red eye
Yes - very severe pain
Purulent discharge
Pus in the anterior chamber
An abrasion, corneal ulcer, or dendritic lesion (herpes simplex keratitis)
Keratitis:
Management:
- Why is an urgent referral for a corneal scrape needed?
- What should be done for contact lens wearers?
What type of radiation causes non-infectious keratitis and where can you be exposed to this type of radiation?
Due to the high risk of sight loss from perforation
UV light from welders or sunbed users without adequate eye protection
Key questions for any case of red-eye?
Is acuity affected? - reduced indicates dangerous pathology
Is the eye painful? - Pain is not a good sign
Do the pupils respond to light? - if not/sluggish, emergency
Is the cornea intact? - use dye to find out
Endophthalmitis:
What is it?
What is the most common cause?
One med that can be given - route?
Inflammation of the aqueous or vitreous humour
A complication of ophthalmic surgery
Intravitreal antibiotics
Corneal ulcers:
What type of pathogens could cause this?
It could be an early sign of ophthalmic shingles. What should be prescribed to prevent this?
What type of eye drops can be prescribed? - C
Bacterial
Herpetic
Fungal
Chloramphenicol ointment
Aciclovir
Chloramphenicol - antibiotic eyedrops
